Since the onset of COVID-19, many states and communities have dramatically loosened restrictions on alcohol and marijuana use and access, including restrictions on delivery, internet sales, takeout, and outdoor consumption.

To explore the impact of these changes on the nation’s health, more than 200 substance misuse prevention practitioners, policymakers, and community activists attended the PS@EDC webinar Policy Implications of    COVID-19 on Alcohol and Marijuana Use, delivered earlier this month.

According to PS@EDC’s Gisela Rots, one of the webinar’s co-presenters, “the downside of these policy decisions is alarming.” Over the past 10 months, alcohol sales and use have increased significantly. Drinking patterns have changed in dangerous ways, with more people drinking more frequently and alone. Unmonitored, off-premises alcohol consumption has been tied to rising domestic violence rates and child abuse and neglect. Legalized marijuana use has led to a troubling increase in underage use.

Justification for these changes includes economic relief for small businesses, COVID safety, and the accepted norm that substance use is a reasonable coping strategy. In the case of marijuana, use is also seen as medicinal for treating anxiety. But weighing the immediate, pressing needs of the small business against the broader public health implications of these changes is “a delicate balance,” says Rots.

“We know from the research literature that “increased availability”—such as being able to pick up the phone and have a fifth of vodka delivered to your door, no questions asked, or ordering cocktails to go from your favorite restaurant, is associated, at a population level, with increased substance use.

“We also know that social norms ‘favorable to use’—for example, the shared belief that having a drink at the end of the day is an acceptable way to deal with the stress and isolation of COVID—is associated with reduced perception of harm. And reduced perception of harm also leads to increased use.”

Also troubling, says Rots, is that the nature of alcohol and marijuana use has also changed since the start of COVID. More people are drinking in isolation and in greater quantities at a single sitting. Both these behaviors increase a person’s risk of developing a substance use disorder in the future.

“Our fear is that policy changes put in place during COVID, such as the push toward contact-less delivery, will become permanent,” says Rots. “It’s hard to put the genie back in the bottle once it’s out.”

What Can Prevention Do?

Rots and co-presenter Chuck Klevgaard outlined a number of steps practitioners can take to monitor and mitigate the effects of these changes, beginning with getting educated. “Find out what’s happening in your own community,” says Rots. “Then reach out to policymakers to raise concerns. It’s never too soon!” Organizations such as the National Alcohol Beverage Control Association maintain interactive data dashboards that allow users to navigate policy changes, by state. Many industry trade organizations, such as the Wine and Spirits Wholesalers of America, have also created resources for tracking state policy changes related to production, distribution, and retail sale.

Rots and Klevgaard also suggest partnering with other organizations to mobilize community support and leverage resources.

“Don’t be afraid to ‘think outside the box’ when considering potential allies,” says Rots. “It’s easy to think of local marijuana dispensaries and alcohol distributors as the opposition. But they share your concerns about the community and can be critical public health partners.”

Rots and Klevgaard also suggest focusing on the long-term. “If we want to be sure the policies we have in place long after the pandemic reflects the latest prevention science, we need to start educating our decision-makers now. We need to make explicit the links between access, norms, and perception of risk.”

To learn more about PS@EDC’s work to address the impact of COVID on substance misuse, contact Gisela Rots at grots@EDC.org.